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Texas rates for HCPCS 15772

Grafting Of Autologous Fat By Lipo Ea Addl 50 Cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.08 / $1,751.00 / $6,691.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,845.00 / $5,646.00 / $8,585.00
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.36 / $1,267.26 / $8,000.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.90 / $123.90 / $123.90
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $724.47
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.43 / $183.18 / $330.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.43 / $186.39 / $356.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.00 / $950.00 / $2,376.00